Researchers say the incidence of serious complications after E. coli infection has remained largely stable for several years, but has risen in Ireland.
Hemolytic uremic syndrome (HUS) is a rare but serious complication associated with E. coli infection that causes kidney failure.
Previous statistics showed no noticeable changes in England, Wales and Northern Ireland. However, in Ireland, the incidence is estimated to have increased threefold. The reason for this is unknown, but is consistent with an increase in Shiga toxin-producing Escherichia coli (STEC) infections.
Four decades after its emergence, HUS remains a significant public health concern, and its incidence has not decreased over time. But scientists say the number of deaths is decreasing.
This study epidemiology and infectious diseasesprovided estimates of childhood HUS incidence in England, Wales, Northern Ireland, and the Republic of Ireland.
Patient and E. coli details
From October 2011 to 2014, 288 HUS patients participated in the study, of which 256 were diagnosed with typical HUS. Ireland had the highest incidence.
The most typical HUS cases were females between 1 and 4 years of age. Ireland had the highest incidence in infants under 1 year of age.
Clinical symptoms include diarrhea and bloody diarrhea, abdominal pain, and fever. The median time from onset of diarrheal symptoms to hospitalization or HUS diagnosis was 6 days.
Sixty-four people were admitted to the pediatric intensive care unit (PICU).
Clinicians reported 177 cases had seemingly made a full recovery at the time they completed the questionnaire. The most common complications at discharge were kidney damage, hypertension, and neuropathy. Only one death was recorded, but other problems occurred relatively frequently, and 69% of cases made a full recovery.
When STEC was isolated, 141 were E. coli O157 and 11 were E. coli O26.
For E. coli O157, 137 isolates were phage typed. The most common type was PT21/28. When toxin types were available, the only predominant one was Stx2, with only eight Stx1+2 strains.
Monitoring system sensitivity
The British Pediatric Surveillance Unit (BPSU) deals with rare childhood diseases in the UK and Ireland. The two previous studies of pediatric HUS were conducted in the United Kingdom and Ireland from 1985 to 1988 and from 1997 to 2001.
Between 2011 and 2014, there were 228 cases in England, 10 in Wales and nine in Northern Ireland. Between 1997 and 2001, there were 287 cases in England, 17 in Wales and 16 in Northern Ireland. Cases in the Republic of Ireland have increased from 30 to 41.
Gaps in culture-positive STEC confirmation from faecal samples limit UKHSA’s ability to detect outbreaks, limit opportunities to implement health protection measures, and determine the true burden of STEC and HUS by different serogroups. , the scientists said.
Comparison of BPSU cases with national surveillance system data showed that the study captured an additional 166 HUS cases. Many were known STEC patients but not confirmed HUS cases. Some of his HUS cases were reported in the surveillance system but not in the BPSU study.
“Our study highlighted the limitations of current STEC surveillance systems for monitoring the clinical burden of STEC and capturing HUS cases. Due to the high prevalence of HUS in children, continued STEC “Surveillance and control remains a public health priority,” the researchers said.
They added that further research is needed to assess whether specific antibiotics may reduce the severity and duration of symptoms in STEC patients.
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